Clinical outcomes in "complex" thoracic aortic surgery.

Although the term "complex aortic surgery" has come into increasing use, it has not been defined. We propose the following definition: replacement or remodeling (not resuspension of commissures) of the aortic root, together with either an intracardiac procedure or a replacement of more than 1 segment of aorta, all of which require cerebral protection. We retrospectively analyzed data pertaining to 152 patients (mean age, 56 +/- 12 years) who underwent surgery for thoracic aortic disease with aid of cardiopulmonary bypass from October 2000 through December 2005. The replaced segment was the ascending aorta with or without the root in 106 patients, the aortic arch in 15, and the descending aorta in 31. Among these patients, 10 met our proposed criteria and constituted the complex group. In this group, in addition to the aortic root, the entire thoracic aorta (ascending, arch, and descending) was replaced in 4 patients, the total arch in 2, and a partial arch in 1. The remaining 3 underwent valve or coarctation repair. Their outcomes were analyzed as a sub-group within the overall outcome. The in-hospital mortality rate was 12.5% in the overall group (19/152), 4.1% in elective cases (3/73), and 10% in the complex group (1/10). Duration of cardiopulmonary bypass, myocardial ischemia, and total cerebral protection times were significantly longer in the complex group (P <0.0001). Total cerebral protection time over 40 minutes was the only predictor of neurologic morbidity (P = 0.003; odds ratio, 4.7). Procedural complexity, as we defined it, increased neurologic morbidity, but not the mortality rate.